One and a Half-stage Total Hip Arthroplasty with Custom-Made Articulating Spacers (CUMARS) for Management of Bilateral Destructive Hip Septic Arthritis - A Case Report

Introduction: Prompt diagnosis and management of septic arthritis are pivotal for early infection eradication, joint preservation, and prevention of quality-of-life impact consequences. Total hip arthroplasty has been introduced for the management of severe destructive septic arthritis with the aims to eradicate infection while preserving hip function. Few case studies have been done on two-stage exchange total hip arthroplasty for treatment of native hip septic arthritis using prosthesis with antibiotic-loaded acrylic cement articulating spacer with generally good outcomes. However, a small percentage of patients electively chose not to proceed with the second-stage exchange arthroplasty. Therefore, 1.5-stage total hip arthroplasty was considered a viable option; however, it has only been established in periprosthetic infection management, but not in native hip septic arthritis. Custom-made articulating spacers are considered an ideal option as has no constraints, are more readily available, and were designed to be a functional single-stage spacer that can remain permanent yet not preclude the possibility of a second-stage exchange surgery if required. Overall, this led to the consideration of 1.5-stage total hip arthroplasty using custom-made articulating spacers for the management of chronic destructive hip septic arthritis.

Case report: We report a 67-year-old patient with functional decline from fully independent without aids to chairbound over 8 months. Work-up revealed raised inflammatory markers and bilateral destructive hip septic arthritis. He underwent bilateral 1.5-stage total hip arthroplasty with antibiotic-loaded custom-made articulating spacers. One-year post-operation, he remains infection-free and is progressing well with rehabilitation - ambulating independently with walking frame.

Conclusion: Management of septic arthritis varies largely depending on infection duration, activity level, and extent of joint destruction. In significantly destructed hip septic arthritis, 1.5-stage total hip arthroplasty using antibiotic-loaded custom-made articulating spacer is a viable option with the benefits of effective infection eradication, good functional outcomes, cost-effectiveness, reduced physical and psychological burden in avoiding a second operation, all whilst not precluding the possibility of a second-stage exchange arthroplasty if required with ease.